| Background and ObjectiveRadical chemoradiotherapy is an important treatment modality for esophageal cancer,but the prognostic factors are not yet clear.The purpose of this study was to analyze the effects and prognostic factors of concurrent chemoradiotherapy for esophageal cancer,to compared high-dose radiotherapy with low-dose,different chemotherapy regimens,and different chemotherapy cycles on patients' OS and PFS,and to investigate the efficacy of consolidation chemotherapy after concurrent chemoradiotherapy(CCRT),and to analyze the safety of concurrent chemoradiotherapy.Material and MethodA total of 307 EC patients of stage ?-? were treated with concurrent chemoradiotherapy in our hospital from September 2006 to July 2014.The age was less than 75 years old,and KPS was more than 70.Patients with stage II-III were medically inoperable or refused,and those with distant metastasis was excluded.The patients were tueated with three dimensional conformal or intensity modulated radiotherapy and total dose of 50Gy-70 Gy were performed.The period of concurrent chemotherapy was more than 2 cycles,and the time of treatment was interrupted.The log-rank test was used for survival difference analysis and univariate prognostic analysis.The Cox regression model was used for multivariate prognostic analysis.Result1.There were 73 patients with stage ? and 234 with stage ?.Age 33-75 years,median age 62 years old.The radiotherapy dose was 50-70Gy(median 60Gy).Concurrent chemoradiotherapy were used with fluorouracil plus platinum(PF,166),paclitaxel plus platinum(TP,82)or platinum only(P,59).Among them,there are 161 for without consolidation group and 146 for consolidation group.2.The 1-,3-5-year OS and PFS rates were85.6%,53.8%,36.9% and 74.6%,43.7%,33.1%,respectively.The median OS and PFS were 41.6 months and 29.8 months.The univariate analysis indicated that T stage,N stage,clinical stage,lesion location,lesion length and chemotherapy regimen were prognostic factors for OS and PFS(P=0.007?0.000?0.000?0.002?0.141?0.018 and 0.013?0.000?0.000?0.000?0.005?0.165).3.Multivariate analysis showed that T stage,N stage,lesion location and chemotherapy regimen were prognostic factors for OS(P=0.024,0.000,0.007 and 0.028),lesion location,lesion length and N stage were prognostic factors for PFS(P=0.004,0.033 and 0.035.4.The median OS for EC patients treated by total dose 50-60 Gy,60.1-70 Gy were 47.4 months and 37.8 months,5-year OS were 37.3% and 35.9%(P=0.469),The median PFS were 34.1 months and 25.1 months,5-year PFS were 33.5% and 32.0%,there was no significant difference(P=0.233).5.The median OS for chemotherapy regimen of PF ? TP and P were 46.5 months,56.0 months and 27.8 months respectively,5-year OS were 40.1%,36.2% and 28.6% respectively,there were significant difference between three group(P=0.018);The median PFS were 33.7 months,25.7 months and 25.8 months respectively,5-year PFS were 34.4%,34.7% and 27.7%,there were no significant difference between three group(P=0.156).6.The median OS for without consolidation group and consolidation group were 45.9 months and 40.6 months,5-year OS were 40.9% and 31.2%(P=0.771),the median PFS 30.8 months and 29.1 months,5-year PFS were 36.7% and 28.3%,there was no significant difference(P=0.688).ConclusionThe outcome of EC patients treated with concurrent chemoratherapy could obtain a long-term survival,combination chemotherapy is superior to single drug,there are no statistical difference between high-dose and low-dose,consolidation chemotherapy did not further prolong progression-free survival and overall survival,and the acute toxic effects can be tolerated. |
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